Mycophenolate Mofetil in the Treatment of Severe Corticosteroid-Dependent or Corticosteroid-Resistant Nail Lichen Planus: A Case Series of 5 Patients.

Introduction: Recent expert recommendations suggest mycophenolate mofetil (MMF) as a third-line therapy, in severe corticosteroid-dependent or corticosteroid-resistant nail lichen planus (NLP). However, there is currently no literature to support MMF use in this indication. This is a retrospective monocentric French case series of 5 patients with severe corticodependant or corticoresistant NLP treated by oral MMF (2-3 g/day), between 2013 and 2021. Case Presentation: The primary outcome was therapeutic success in a target fingernail. All 5 patients showed some clinical improvement, ranging from mild improvement (1/5) to clinical cure (2/5). Clinical improvement was more significant when the drug was taken for a longer period (24 months vs. 4 months) and at a higher dose (3 g/day vs. 2 g/day). Relapse occurred after stopping or tapering the MMF dose. MMF was well tolerated. Discussion/Conclusion: MMF may be a treatment to consider for severe corticosteroid-dependent or corticosteroid-resistant NLP. The long-term safety of this treatment warrants further investigation.

Myasthenia Gravis Lambert-Eaton overlap syndrome induced by nivolumab in a metastatic melanoma patient.

INTRODUCTION: Myasthenia gravis (MG) Lambert-Eaton (LE) overlap syndrome is a rare condition. Here, we describe the first case of MG-LE overlap syndrome revealed by the anti-programmed cell death 1 inhibitor, nivolumab, in a patient treated for metastatic melanoma. CASE: Three months after receiving nivolumab and 1 month after brain metastasis radiotherapy, our patient developed generalized fatigue with intermittent ptosis and swallowing difficulty suggesting a myasthenic syndrome. Electromyogram findings, anti-acetylcholine receptor, and anti-calcium channel antibodies levels were consistent with an immune-related myasthenic syndrome with specific features for both MG and LE syndromes. Immunotherapy with nivolumab was stopped. Patient was treated with systemic immunosuppressive and anti-cholinesterase drugs, with remarkable improvement of his neurological symptoms. Prolonged partial remission was obtained for his metastatic melanoma without need for a third-line treatment. Two years later, a relapse of hismyasthenic symptoms was observed along with new neurological symptoms related to brain radiation necrosis. CONCLUSION: We describe the first case of MG-LE overlap syndrome diagnosed after anti-PD1 immunotherapy for metastatic melanoma, which appeared after radiation therapy and then relapsed after brain radiation necrosis. We hypothesized a role for brain inflammation as a trigger for MG-LE onset. Neuro-muscular junctions disease induced or revealed by checkpoint inhibitors can be challenging and requires long-term follow-up.

Efficacy and Safety of Tacrolimus 0.1% for the Treatment of Facial Vitiligo: A Multicenter Randomized, Double-Blinded, Vehicle-Controlled Study.

BACKGROUND: Topical calcineurin inhibitors are used off label in the treatment of vitiligo, and there is a lack of placebo-controlled, blinded studies to support their use. OBJECTIVE: This study aimed to compare the efficacy of tacrolimus 0.1% ointment with that of the vehicle for repigmentation in adult patients with facial vitiligo. DESIGN: This study was a 24-week multicenter randomized parallel double-blind study with a 24-week post-treatment follow-up extension. POPULATION: Participants included were adult patients with recent facial vitiligo target lesions (<2 years) without changes in pigmentation or size over the previous 3 months. INTERVENTION: Patients received either tacrolimus 0.1% ointment or vehicle twice daily. MAIN OUTCOMES AND MEASURES: The primary outcome was a therapeutic success, defined as a change ≥75% in the repigmentation of the target lesion between baseline and week 24, measured by ImageJ software. Secondary outcome measures were a variation of the physicians' global assessment scores and patients' satisfaction scores, safety data, and the rate of relapse at week 48. RESULTS: A total of 42 patients were included. Therapeutic success was achieved in 65% of tacrolimus-treated patients versus 0% of vehicle-treated patients at week 24 (P < 0.0001). Only 40% of relapse was observed at 48 weeks. CONCLUSIONS AND RELEVANCE: Twice-daily tacrolimus 0.1% ointment showed superior efficacy to that of the vehicle through the 24 weeks of intervention and 24 weeks of follow-up in adult patients with facial vitiligo. TRIAL REGISTRATION: This study was registered at ClinicalTrials.gov (identifier: NCT02466997).